Nerve Root Injections (Transforaminal Epidural)

What is a Nerve Root Block (Transforaminal Epidural)?

A nerve root block is a procedure used to diagnose and treat pain associated with nerve root compression. The nerve roots are part of the spinal cord that exits the spine and extends to various parts of the body. When these nerve roots become compressed or inflamed, it can result in pain, numbness, or weakness in the area served by the affected nerve.

What happens before the Nerve Root Block?

Before a nerve root block procedure, the patient will typically undergo a thorough evaluation by a specialist to determine the underlying cause of their pain and whether a nerve root block is an appropriate treatment option. This evaluation may include a physical exam, medical history review, and diagnostic tests such as imaging studies (e.g., X-rays, MRI, CT scans) or nerve conduction studies.

If the specialist determines that a nerve root block is appropriate, the patient will typically receive instructions on preparing for the procedure. This may include:

  • Discontinuing the use of blood-thinning medications, such as warfarin, for a specified period before the procedure
  • Do not stop any medication before talking to us.
  • Arranging for someone to drive them home after the procedure. Frequently, the procedure can result in temporary numbness and weakness in the affected arm/leg. We, therefore, advise you not to drive for 24 hours following the injection.
  • Inform us of any allergies, medications, or medical conditions you have. If there is an active infection, the procedure is not carried out.

What happens during the procedure?

The nerve root block is an outpatient procedure that is conducted in the hospital under local anaesthesia and sometimes under sedation.

The procedure is performed in a room equipped with a fluoroscopy(X-ray). Although the injections only take a short time, the entire procedure may last up to 30 minutes.

During the procedure, the patient will be asked to lie on their front, and the doctor will take measures to ensure their comfort. The doctor will clean the skin of the neck or back area with antiseptic and cover it with sterile drapes. Local anaesthesia will then be injected into the skin to numb the area.

Next, the doctor will use X-ray images to guide the needle to the correct position and confirm its location by injecting a small amount of X-ray dye next to the nerve. Finally, a mixture of local anaesthesia and steroid will be slowly injected in and around the nerve, and the needle will be removed.

After the procedure, which usually takes around 30 minutes, the patient will be monitored briefly and then typically allowed to go home within half an hour.

During the procedure, your vitals are continuously monitored.

What can I expect after the injection?

The injection of local anaesthesia may result in immediate symptom relief.
However, it may also cause numbness or weakness in the affected arm or leg for up to 24 hours, so caution should be taken when mobilizing, especially when carrying items.
On the other hand, the steroid medication usually takes two to three days to start taking effect and may peak at one to two weeks. It's important to continue regular pain relief medication as needed.
The success of the injection in reducing pain and its duration may vary from person to person.

What are the potential side effects of the procedure?

The most frequently observed side effect of the injections is mild tenderness and/or bruising at the injection site, which typically resolves within a few days. Individuals may sometimes experience increased pain for a few days following the injection, but this should subside.
Although uncommon, more severe side effects, such as bleeding, infection, nerve damage, or an allergic reaction to the medications used during the procedure, may occur.
Although rare, seeking medical attention promptly is important if you feel unwell.

Please follow the BASS (British Association of Spinal Surgeons) website for more information.

Learn more about conditions:

Leg Pain (Sciatica): Discover the causes and symptoms of leg pain associated with sciatic nerve irritation.
Arm Pain (Cervical Radiculopathy)
: Explore the origins and symptoms of arm pain stemming from cervical nerve root issues.